Effects of Intensive BP Control in CKD : Journal of the American Society of Nephrology (original) (raw)

Clinical Research

Cheung, Alfred K.*; Rahman, Mahboob; Reboussin, David M.; Craven, Timothy E.; Greene, Tom; Kimmel, Paul L.**; Cushman, William C.; Hawfield, Amret T.; Johnson, Karen C.; Lewis, Cora E.; Oparil, Suzanne; Rocco, Michael V.; Sink, Kaycee M.***; Whelton, Paul K.; Wright, Jackson T. Jr.; Basile, Jan; Beddhu, Srinivasan*; Bhatt, Udayan; Chang, Tara I.; Chertow, Glenn M.; Chonchol, Michel****; Freedman, Barry I.; Haley, William; Ix, Joachim H.; Katz, Lois A.; Killeen, Anthony A.; Papademetriou, Vasilios*****; Ricardo, Ana C.; Servilla, Karen; Wall, Barry; Wolfgram, Dawn; Yee, Jerry******; for the SPRINT Research Group

Collaborators

Cheung, Alfred K.; Rahman, Mahboob; Reboussin, David M.; Craven, Timothy E.; Greene, Tom; Kimmel, Paul L.; Cushman, William C.; Hawfield, Amret T.; Johnson, Karen C.; Lewis, Cora E.; Oparil, Suzanne; Rocco, Michael V.; Sink, Kaycee M.; Whelton, Paul K.; Wright, Jackson T. Jr.; Basile, Jan; Beddhu, Srinivasan; Bhatt, Udayan; Chang, Tara I.; Chertow, Glenn M.; Chonchol, Michel; Freedman, Barry I.; Haley, William; Ix, Joachim H.; Katz, Lois A.; Killeen, Anthony A.; Papademetriou, Vasilios; Ricardo, Ana C.; Servilla, Karen; Wall, Barry; Wolfgram, Dawn; Yee, Jerry

*Division of Nephrology and Hypertension and

¶Department of Population Health Sciences, University of Utah, Salt Lake City, Utah;

†Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah;

‡Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University Hospitals, Cleveland, Ohio;

§Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio;

‖Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina;

**Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;

††Hypertension Section, Medical Service and

§§§§§Nephrology Section, Internal Medicine, Memphis Veterans Affairs Medical Center, Memphis, Tennessee;

‡‡Department of Internal Medicine, Section on Nephrology and

***Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina;

§§Department of Preventive Medicine and

‖‖‖‖‖Department of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;

‖‖Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama;

¶¶Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;

†††Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;

‡‡‡Department of Medicine, Medical University of South Carolina, Charleston, South Carolina;

§§§Primary Care Research, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina;

‖‖‖Division of Nephrology, Ohio State University Medical Center, Columbus, Ohio;

¶¶¶Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California;

****Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado;

††††Division of Nephrology and Hypertension, Mayo Clinic Florida, Jacksonville, Florida;

‡‡‡‡Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, California;

§§§§Medical Service, Veterans Affairs New York Harbor Healthcare System, New York, New York;

‖‖‖‖Department of Medicine, New York University School of Medicine, New York, New York;

¶¶¶¶Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota;

*****Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC;

†††††Department of Medicine, Division of Nephrology, University of Illinois, Chicago, Illinois;

‡‡‡‡‡Renal Section, Medicine Service, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico;

¶¶¶¶¶Section of Nephrology, Department of Medicine, Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin; and

******Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan

Correspondence: Dr. Alfred K. Cheung, Division of Nephrology and Hypertension, 295 Chipeta Way, Room 4000, Salt Lake City, UT 84108. Email: [email protected]

Abstract

The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of <120 mm Hg (intensive group; _n_=1330) or <140 mm Hg (standard group; _n_=1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participants with and without CKD (P values for interactions ≥0.30). The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (−0.47 versus −0.32 ml/min per 1.73 m2 per year; P<0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.